Standardized testing with chlorhexidine in perioperative allergy – a large single‐centre evaluation

Opstrup, Morten Schjørring; Malling, Hans‐Jørgen; Krøigaard, Mogens; Mosbech, H.; Skov, Per Stahl; Poulsen, Lars K.; Garvey, Lene Heise

doi:10.1111/all.12466

Cited by 120 publications

(142 citation statements)

References 30 publications

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“…Significant geographical differences are reported concerning the incidence of chlorhexidine-perioperative induced anaphylaxis. Reactions are quite frequent in UK and Scandinavian countries [71,103,104], representing the 8.7%-9.6% of cause inducing perioperative anaphylaxis but relatively rare in France [22] perhaps because of its limited use in the operating room. The mechanism is IgE mediated and although reactions usually appear 20-30 minutes after its administration, onset and severity depend on the administration route, with cutaneous application rarely causing severe reaction [36].…”

Section: C) Antiseptics and Sterilizersmentioning

confidence: 99%

“…Skin prick tests with latex also show a high sensitivity and specificity (grade of recommendation, B) (93% and 100%, respectively) [122]. Clorhexidine also has a high sensitivity and specificity: 95% and 97% respectively for skin prick tests and 68% to 100% for intradermal tests (grade of recommendation, B) [103].…”

Section: Skin Testsmentioning

confidence: 99%

“…In these cases there is no indication of performing STs (grade of recommendation, B) [12,118,128] ii) patients with a previous history of reactions, with detailed information available regarding the reaction kinetics and drugs and agents administered. In these cases, STs are mandatory for all the agents administered plus latex [129] and clorhexidine [71,103,104,130] (grade of recommendation, C), however ST results may not be reliable until 4-6 weeks after the initial reaction [131]; iii) Patients with reactions but without clear information about the episode, which is the most complex scenario, especially when there is a long interval between the reaction and the study. In this case the type of surgery and anaesthesia and severity of the reaction can help to decide the agents to test, nevertheless it is recommended to perform ST with all the essential agents needed for anaesthesia, including a muscle relaxant derivative and an opioid (grade of recommendation, D) ( Table 3).…”

Section: Skin Testsmentioning

confidence: 99%

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Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

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Perioperative hypersensitivity reactions constitute a first-line problem for anesthesiologists and allergists, so it is advisable that hospitals have a consensus protocol for the diagnosis and management of these reactions. However, this kind of protocols is not present in many hospitals, leading to problems in treatment, the communication of incidents and subsequent etiological diagnosis. In this document we present a systematic review of the available scientific evidence and provide general guidelines for the management of acute episodes and Resumen:Las reacciones de hipersensibilidad perioperatorias constituyen un problema de primera línea para los anestesiólogos y alergólogos, por lo que es recomendable que los hospitales tengan un protocolo de consenso para el diagnóstico y el tratamiento de estas reacciones. Sin embargo, este tipo de protocolos no está presente en muchos hospitales, lo que conlleva problemas en el tratamiento, la comunicación de incidentes y el posterior diagnóstico etiológico. Este documento ha sido creado por miembros del Comité de Alergia a Medicamentos de la Sociedad Española de Alergia e Inmunología Clínica (SEAIC) en colaboración con miembros de la Sociedad Española de Anestesia (SEDAR). Se ha realizado una revisión sistemática de la evidencia científica disponible y se proporcionan pautas generales para el manejo de episodios agudos y para la derivación de pacientes con reacciones de hipersensibilidad perioperatoria a los Servicios de Alergología. Se propone un algoritmo práctico para el diagnóstico etiológico y se brindan recomendaciones para el manejo de pacientes con reacciones alérgicas perioperatorias.

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Section: C) Antiseptics and Sterilizersmentioning

confidence: 99%

Section: Skin Testsmentioning

confidence: 99%

Section: Skin Testsmentioning

confidence: 99%

See 1 more Smart Citation

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

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show abstract

“…Chlorhexidine is an increasingly recognized cause of anaphylaxis. Although the actual incidence of anaphylaxis regarding this agent is unknown, a study of patients that had had perioperative anaphylaxis revealed that 9.6% of them had a positive skin test to chlorhexidine [13,14].…”

Section: Discussionmentioning

confidence: 99%

Anaphylaxis and cardiac surgery for hypertrophic obstructive cardiomyopathy: a case report and review of anaesthetic management

Yee

Wąsowicz

2016

Anaesthesiol Intensive Ther

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Background: The aim of this paper is to describe clinical management in a situation where patient has experienced anaphylaxis while undergoing surgical septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM). Case report: A 40-yr-old female was scheduled to undergo surgical septal myectomy for the treatment of HOCM. After induction, the patient developed refractory hypotension that did not respond to escalating doses of vasopressors and volume therapy. Although a clinical examination led to the diagnosis of anaphylaxis, epinephrine, which is the usual treatment of choice, failed to improve the patient's haemodynamics. A transesophageal echocardiography revealed a worsening of left ventricular outflow tract obstruction (LVOTO) after epinephrine administration. In the end, the rapid institution of a cardiopulmonary bypass was required as a rescue therapy instead of to save a patient. Conclusion:The anaesthetic goals in a patient in HOCM are to maintain preload and afterload and to avoid stimulation of inotropy and chronotropy to leading to left ventricular outflow obstruction. In a patient with anaphylaxis, maintaining these haemodynamic goals becomes much more difficult since the pathophysiology and usual treatment of choice will worsen LVOTO. Special consideration for the need to have extracorporeal life support to treat refractory hypotension in surgical patients with HOCM may be warranted.

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“…Because of highly efficient avoidance strategies, the prevalence of anaphylaxis to latex declined during the last years and is now considerably less than would be suggested by the presence of specific IgE (sIgE) or positive skin tests (6). Instead, increasingly other elicitors of anaphylaxis have been reported in the perioperative setting (2,7,8).…”

mentioning

confidence: 99%